Value-based care: The pros and cons

As healthcare organizations transition to value-based care, they find the model has pros and cons, according to a blog post from NEJM Catalyst


Some physicians are concerned that the model asks too much of them, according to the post, which reviewed the results of healthcare leaders' responses to the Catalyst Insights Council Survey. For example, Caroline Poplin, M.D., a physician at the Arlington Free Clinic in Virginia, said that some doctors feel it will merely increase their patient load, and it makes them responsible for wellness issues that are beyond their typical scope. “What internists like me should be doing is coordinating care . . . not organizing someone’s effort to lose weight,” Poplin said.

The demands of a value-based system can lead to harder, less satisfying work for physicians, Poplin said in the post. She gave the example of an obese patient coming to a clinic with a cold; doctors must also remember to talk to the patient about cholesterol levels and healthy body weight, even though that is not directly to the patient’s reason for seeking care.

Laurie Gianturco, M.D., vice president and chief medical officer for Health New England, a provider-owned, non-profit health plan, said in the piece that supporting and engaging physicians is key because of the burdens now placed upon them in a value-based care model. Gianturco told Catalyst that she’s optimistic that value-based care will improve quality, control costs and better align providers, but acknowledged that physicians may not have yet seen proof of the benefits and may be skeptical.

Paul Nelson, MD, primary care physician at Family Health Care PC in Omaha, Nebraska, is among those skeptics and is not convinced value-based care will actually improve quality. New payment models, he told the publication, “discount” the role primary care physicians play in healthcare, and that is why, as a 40-year veteran doctor, he has decided to retire.

One of the survey respondents, a vice president of practice transformation at a midsized health institution in the South who requested NEJM Catalyst not use her name, said she has heard similar complaints before. “[Value-based payments] are going to hurt and are going to be painful, but everyone has to understand that healthcare costs were untenable and something had to change,” she told NEJM Catalyst.

- read the blog post